Urinary Incontinence is a common, debilitating and costly problem in middle-aged and older women. The prevalence of this condition appears to increase in women between 45-55 years old, an age range that coincides with the menopausal transition. Yet little is known about how the physiological changes associated with mid-life and ovarian aging affect incontinence. This study addresses the first two goals of the NIA RFA Aging through the Lifespan; our interdisciplinary team will examine longitudinally how life- course pathways and differences in risk factors affect urinary incontinence. OBJECTIVE: Our specific aims are: 1) to examine how the incidence and changes in prevalence of incontinence by type (stress, urge, mixed) vary over the stages of the menopausal transition; 2) to identify mid-life physical and psychosocial factors in the development, progression and regression of incontinence by type over 10 years, 3) to explore associations between incontinence and the hormonal changes of the menopausal transition; and 4) to examine the role of race/ethnicity in these specific aims. METHODS: The Study of Women's Health Across the Nation (SWAN) is a longitudinal cohort of 3300 Caucasian, African-American, Chinese, Japanese and Hispanic women who are being followed to characterize the menopausal transition. Our study proposes to use 10 years of questionnaire data with physical and hormonal measures in SWAN to investigate the development and determinants of change in incontinence symptoms across the menopausal transition and into the postmenopausal period. This proposal will primarily involve multivariable regression analysis of ordinal outcomes with mixed models in which random effects are used to model the unmeasured systematic subject-specific sources of variability. RATIONALE: Longitudinal studies that investigate causal sequences and factors associated with the development, progression and regression of incontinence are now needed to improve knowledge about the etiology of incontinence as women age. This investigation will provide this important and novel information that would be otherwise difficult to obtain. With this information we hope to help clinicians advise and treat incontinent mid-life and aging women and to inform incontinence prevention strategies by identifying modifiable risk factors for incontinence and factors associated with improving incontinence.